Report on Measles Outbreak From January 2018 to February 2019

in Cogon Pardo, Cebu City, Cebu, Central Visayas

Group 7

Tonee Abella
Gabriel Amobi
John Patrick Noel Caintic
Peter John Carlobos
Carla Kate Cueva
Belle Escarda
Kathleen Geonzon
Jacques Simon Gonzales
Goldameir Israel
Joan Audrey Faith Odi
Michelle Mae Pugoy
Aaron Paul Solante
Sharrah Tan

Date Submitted:
May 3, 2019
 Measles is a highly contagious viral disease caused by a spherical, nonsegmental,
single-stranded, negative-sense RNA virus. It is transmitted primarily by respiratory droplets over
short distances and, less commonly, by small-particle aerosols that remain suspended in the air for
long periods. It has an incubation period of approximately 10 days to onset of prodromal illness of
fever, cough, coryza, and conjunctivitis followed by the appearance of a generalized maculopapular
rash starting at the hairline and moves down the body, typically sparing the palms and soles. The
appearance of Koplik’s spots (1- to 2-mm white or bluish lesions with an erythematous halo on the
buccal mucosa) are pathognomonic for measles (Kaye and Kaye 2018, Rainwater-Lovett and Moss
2018).
The chain of transmission are common among household contacts, school-aged children, and
health care workers. A delay in the diagnosis of an infected patient with measles contributes to
transmission and, henceforth, outbreak to begin (Gahr et al 2014). An infected person is contagious
from days 4 before until 4 days after rash appearance. Newborns become susceptible to measles virus
infection when passively acquired maternal antibody is lost. When not vaccinated, these infants
account for the bulk of new susceptible individuals (Rainwater-Lovett and Moss 2018). Therefore,
vaccination is the central focus in prevention and management of measles (Bester JC 2016).

OCCURENCE OF MEASLES IN COGON PARDO

Total Population: 19,099 (M = 9615, F = 9482)

Total Number of Cases: 4
Case #1: 6 months old, M Case #3: 7 months old, F
Case #2: 7 months old, F Case #4: 5 months old, F

1. Mortality Rate
According to the barangay health workers’ record, all four suspected cases of Measles were
referred to tertiary hospitals for admission. There was no information regarding the discharge status of
the patients. Thus, mortality Rate could not be solved.

2. Incidence Rate
In a population of 19, 099 from January 2018 to February 2019, 4 new cases of measles were
reported within the same month of February 2019 with an incidence rate of:
(4 / 19,099) x 10, 000 = ​2.09 per 10, 000 people

3. Age-Specific Rate
Within the 0-5 months old age group, only 1 case out of 267 was found with the following
age-specific rate:
(1 / 267) x 100 = ​0.375 per 100 0-5 months old

Within the 6-11 months old age group, only 3 cases out of 205 were found with the following
age-specific rate:
(3 / 205) x 100 = ​1.463 per 100 6-11 months old

4. Gender-Specific Rate
There is 1 out of 9615 measle cases among males and 3 out of 9482 among females.
(1 / 9,615) x 10000 = ​1.04 per 10000 males
 (3 / 9,484) x 10000 = ​3.16 per 10000 females

5. Case Fatality Rate

The case fatality rate for the measles cases in Cogon Pardo could not be solved. There was
insufficient data regarding the proportion of deaths within the confirmed measles cases because the
barangay health workers' reports did not include the discharge status of the measles infected
individuals.

6. Epidemic Curve
For the months of January 2018 to February 2019, there has only been 4 measles cases in
Barangay Cogon Pardo, Cebu City. Most of the cases were clustered within the month of February
2019.

Figure 1. ​Brgy. Cogon, Pardo Measles Cases from January 2018 to February 2019.

Figure 2. ​Brgy. Cogon, Pardo Measles Cases for February 2019.

 HYPOTHESIS

Null Hypothesis​: There is no outbreak of measles infection in Cogon Pardo, Cebu City.
Alternative Hypothesis​: There is an outbreak of measles infection in Cogon Pardo, Cebu City.

An outbreak is the occurrence of cases of disease in excess, that is often sudden, of what
would normally be expected in a defined community, geographical area or season. It can also be
defined as a single case of a communicable disease long absent from a population, or caused by an
agent not previously recognized in that community or area, or the emergence of a previously unknown
disease, may also constitute an outbreak and should be reported and investigated (WHO SEARO
2019).
Figure 1 shows that measles infection is normally absent with 0 cases per month in the
barangay from January 2018 to January 2019. Following the definitions above, the sudden increase in
the month of February with 4 cases out of 19,099 people within the population would indicate that
there is an apparent outbreak of measles infection in Cogon Pardo, Cebu City. Moreover,
unvaccinated infants between 5 to 7 months diagnosed with measles infection (Appendix) visibly
presents the susceptibility of unvaccinated newborns to measles. However, the possibility that the
Barangay Health Center was not notified causing underestimation of the true number of infected
patients in the area should be taken to mind. Such patients may have been directed immediately to
secondary or tertiary health care institutions in Cebu.

PLANS OF INTERVENTION

1. Patient-Centered Plans
a. Avoid busy schedules and take time for rest
b. Drink lots of water and fruit juices
c. Seek respiratory relief

2. Family-Centered Plans
Misconceptions and fears regarding the safety of the vaccine, lack of trust to the health care
system, and dissatisfaction with the quality of discussion about vaccination has been linked to parental
hesitation and lower vaccine uptake (Bester JC 2016). Education has to be elaborated and reinforced
with the dire need for measles eradication. This could be done by enlightening parents regarding the
transmission of measles and its physical presentation. Moreover, the compliance and completion of
the vaccination doses should be emphasized, especially that it is a cost-effective method for
prevention.

3. Community-Centered Plans
The community is the seedling that, if cultivated properly, will strengthen the overall health of
the whole country. Thus, what is done in the community is very essential. First of all, having known
that measles is a vaccine-preventable disease, strengthening the community coverage of vaccination
rates will have a cascading effect; in turn, it will improve the herd immunity not only of the the
community but of the country as well. No one should be exempted from vaccination including health
workers and at least 95% of children in the community for it to attain a full protection status (WHO
2019). To be able to help in its achievement, there should be a collaborative effort with international
organizations, national and local government units, and even non-government units and private health
workers.
Second, to be able to activate the community, we need to have an empowered and properly
educated manpower. There should be training conducted for the barangay health workers and other
community health workers because if they will understand the extent of severity of this disease, they
themselves will be proactive and hands-on against the activities against measles in the community.
Furthermore, education should not be limited to them but more so to the people in the community.
Everyone in the community must be informed about the disease, its signs and symptoms, what to do
and most importantly, how to prevent it by vaccination.
Lastly, there should also be better case detection and containment in the community.
Surveillance in the community should be improved as well, especially if the people in the community
are well informed of the clinical signs and symptoms of the disease, then, there will also be an
effective reporting of possible and positive cases. Measles will not be eradicated overnight, it will not
also be eradicated with the effort of just a few people, instead, it requires the effort of the whole
nation, thus every single effort in the community counts.

REFLECTION

Every administration conducts reforms on the healthcare system all geared towards providing
the public better services. Yet, no matter how advanced or modified these agendas are in theory, poor
execution and implementation would still deem them ineffective. This is why it is important to
strengthen and give more support to the barangay health units so these reforms could all be realized
and maximized. Emphasis should be given that barangay health centers are involved in primary level
of health care. They are our primary movers and the frontline of public health and it is just right for
them to be equipped with knowledge, facilities and supplies to cater to the health demands of the
public, especially in the prevention of avertible diseases such as measles and other infectious diseases.
The community must be aware that they have these institutions to turn to in times of need.
One area we think needs improvement is record keeping. During our visit, we noticed that
everything was still manually recorded and some of them could not be recovered due to loss and
damage. Perhaps it would be helpful to have a better record system so that there will be more
convenient, faster and more accurate data access for future use.
Measles is an epidemic now. The recent outbreak of measles cause all to be cautious of it.
From our case, we can see that it's mostly affected children especially less than a year old and all these
children have something in common, they are not yet vaccinated. By this alone, this proves to us how
important vaccination is in preventing diseases. Prevention is always better than cure.
On a more positive note, we think it’s a good sign that the measles mortality rate is not high in
this area. This information, however, might be misleading as two things can be deduced: it’s either the
cases are not religiously recorded since as mentioned prior, there is no proper order in record-keeping
or they have implemented their vaccination program well enough given the measles outbreak.
Still, every barangay health center is encouraged to have full coverage pertaining to providing
vaccinations for Measles, as many regions in the Philippines have high prevalence and Measles is a
vaccine-preventable disease. Vaccination has also been a very efficient tool for the prevention and
control of Measles, as it is sustainable, cost-effective and most importantly, effective.
REFERENCES
 Bester JC. 2016. Measles and Measles Vaccination A Review. JAMA Pediatrics, 170(12):
1209-1215.
Gahr P, DeVries AS, Wallace G, Miller C, Kenyon C, Sweet K, Martin K, White K, Bagstad
E, Hooker C, Krawczynki G, Boxrud D, Liu G, Stinchfield P, LeBlanc J, Hickman C,
Bahta L, Barskey A, Lynfield R. 2014. An Outbreak of Measles in an
Undervaccinated Community. Pediatrics, 134(1):e220-e228.
Kaye ET, Kate KM. 2018. Fever and Rash. In: Jameson JL, Kasper DL, Longo DL, Fauci AS,
Hauser SL, Loscalzo J, editors. Harrrison’s Principles of Internal Medicine (20th
Edition). p. 106.
Rainwater-Lovett K, Moss WJ. 2018. Measles (Rubeola). In: Jameson JL, Kasper DL, Longo
DL, Fauci AS, Hauser SL, Loscalzo J, editors. Harrrison’s Principles of Internal
Medicine (20th Edition). pp 1474-1478.
WHO SEARO 2019. Disease Outbreaks. Accessed May 1, 2019 at www.searo.who.int/
topics/disease_outbreaks/en/.

APPENDIX
Name of Barangay: Cogon Pardo
Total Population: 19,099
Age-Specific and Gender-Specific Population:

Age Male Female Total (Age) Age Male Female Total (Age)

0-5 months 123 144 267 35-39 years 747 724 1471

6-11 months 103 102 205 40-44 years 651 666 1317

12-23 months 262 252 514 45-49 years 574 611 1185

24-35 months 217 197 414 50-54 years 486 504 990

36-47 months 206 188 394 55-59 years 462 454 916

48-59 months 177 210 387 60-64 years 238 255 493

60-71 months 218 162 380 65-69 years 195 208 403

7-9 years 708 696 1404 70-74 years 126 134 260

10-14 years 778 756 1534 75-79 years 104 92 196

15-19 years 850 770 1620 80-84 years 52 60 112

20-24 years 790 736 1526 85-90 years 32 35 67

25-29 years 785 787 1572

30-34 years 731 741 1472 TOTAL 9,615 9,484 19,099

Total Number of cases affected by Measles at January 2018 to February 2019: ​4

Case #1: ​Age: 6 months old Gender: Male

Date of admission: February 9, 2019 Diagnosis: Measles Pneumonia

(​Record of patient was not available)​

Case #2: ​Age: 7 months old Gender: Female

Date of admission: February 12, 2019 Diagnosis: Measles
Total household members 3

Immunization Status of BCG DPT/Polio Measles Rotavirus Hep B Others

each member

Index Patient ✓ ​(at ✓ ​(3rd ✓ ​(AMV; N/A ✓ PCV: ​✓

birth) dose) 1st dose at (3rd dose)
March 27,
2019)

Mother N/A N/A N/A N/A N/A N/A

Father N/A N/A N/A N/A N/A N/A

Number of Affected 1
household members

Presenting Signs and N/A

Symptoms
 Number of days with N/A
symptoms before brought to
health center

Risk factors of the affected Nutritional Status: N/A

case Current Medical Co-morbidities: N/A

Case #3: ​Age: 7 months old Gender: Female

Date of admission: February 16, 2019 Diagnosis: Measles
Total household members 3

Immunization Status of BCG DPT, OPV Measles Rotavirus Hep B Others

each member

Index Patient ✓ ​(at ✓ ​(3rd ✓ ​(AMV; N/A ✓ PCV: ​✓

birth) dose) 1st dose at (3rd dose)
April 4,
2019)

Mother N/A N/A N/A N/A N/A N/A

Father N/A N/A N/A N/A N/A N/A

Number of Affected 1
household members

Presenting Signs and N/A

Symptoms

Number of days with N/A

symptoms before brought to
health center

Risk factors of the affected Nutritional Status: N/A

case Current Medical Co-morbidities: N/A

Case #4:​ Age: 5 months old Gender: Female

Date of admission: February 25, 2019 Diagnosis: Measles

(​Record of patient was not available)​